Can remote social contact replace in-person contact to protect mental health among older adults?

Abstract

Older adults have been encouraged to replace in-person contact with remote modes of contact to prevent the spread of COVID-19. However, it is unclear whether remote contact effectively substitutes for the protective effects of in-person contact on mental health.1, 2 We aimed to determine whether increased frequency of phone, video call, or messages during the pandemic compensates for reduced in-person contact in moderating changes in mental health compared with pre-pandemic levels. A better understanding of how various modes of social contact contribute to mental health can inform strategies relevant to caring for and supporting millions of older adults who are beginning to recover from the isolating effects of the pandemic or are isolated for reasons extending beyond the pandemic. The National Social Life, Health, and Aging Project (NSHAP) is a nationally representative study of older adults interviewed in 2005, 2010, and 2015.3, 4 The COVID sample includes 4852 NSHAP respondents. Surveys were conducted between September 14, 2020 and January 27, 2021, via web, phone, and paper-and-pencil. Responses from 2672 individuals resulted in a conditional response rate of 58.1% for both cohorts combined. Our analytic sample (Table S1) included 2554 respondents aged 55 years or older who were also interviewed in 2015. Questions included how often, during a typical week since the pandemic started, respondents had social contact with non-household (a) family and (b) friends, by (i) phone, (ii) messages (email, text, social media), (iii) video calls (FaceTime, Skype, Zoom), and (iv) in-person.5 Follow-up questions included whether each mode of frequency represented an increase, decrease, or no change compared with pre-pandemic. Mental health measures included general life happiness (1–5, unhappy to happy),6 depressive feelings during the last month (1–4, rarely/never to most of the time),7 and the 3-item UCLA loneliness scale (3–9, never to often lonely).8 Approximately one-third of the sample reported at least weekly in-person contact with family (37%) or friends (31%), and nearly a quarter reported no in-person contact with family (22%) or friends (25%). Most reported regular contact with family or friends via phone (78% vs. 60%) or messaging (69% vs. 63%), whereas only 25% and 17% reported regular video calls with family and friends, respectively. At least half of older adults reported never using video calls with family (49%) or friends (60%) since the pandemic started. Contact frequencies and changes in contact frequencies for each mode with family and friends are shown in Table S2. Most respondents did not change how often they used each mode of social contact after the pandemic started. However, 38% reported less in-person contact with family (40% for friends) during the pandemic and some increased in-person contact (8% family, 6% friends). Only 16%–26% of the sample reported increased remote contact with family or friends depending on mode. Regression model results are reported in Table S3. Figure 1 shows the value of coefficients linking decreased in-person contact with family during the pandemic with less happiness, more frequent depressive feelings, and greater loneliness relative to 2015. Similarly, in these same models, those who had decreased in-person contact with friends became less happy, and more frequently depressed and lonely. In combination, loss of in-person contact with family and friends was associated with a 0.29 standard deviation (SD) reduction in happiness, a 0.23 SD increase in depressive feelings, and a particularly large 0.46 SD increase in feelings of loneliness. Increased remote modes of contact had no significant effects after accounting for in-person effects. The pattern of results remained unchanged in analyses using inverse probability weights (Table S4). In a nationally representative sample of older adults, our data converge with prior research showing that in-person contact cannot be replaced by remote modes of contact in maintaining mental health.1, 9, 10 Individuals experienced loneliness, depression, and reductions in happiness despite increases in remote contact. However, our data also showed low rates of uptake of three different remote modes of contact during the pandemic. This may reflect lack of access, ability, and/or interest in using technology-mediated connection. If remote modes of contact are to have mitigating effects for mental health, they may not be evident until frequency exceeds the levels seen in this study. Our study is limited by its retrospective reports of changes in contact frequency since the pandemic. Prospective data are needed to assess a causal role for remote contact—and the amount and type of such contact needed—to protect well-being. In conclusion, results suggest that adaptive strategies are needed to facilitate safe in-person contact for the millions of U.S. older adults experiencing adverse mental health effects from social isolation. The authors have declared no conflicts of interest for this article. Louise C. Hawkley and Laura E. Finch planned the study. Laura E. Finch performed all data analysis. Louise C. Hawkley wrote the first draft of the manuscript. All authors revised the manuscript, interpreted results, and approved the final manuscript. The sponsor had no role in the design, methods, data collection, analysis, or preparation of the article. This work and the NSHAP (PI: Linda J. Waite) were supported by the National Institute on Aging and the National Institutes of Health (grant numbers R01AG021487, R37AG030481, R01AG033903, R01AG043538, and R01AG048511). The NSHAP COVID-19 study reported here (PI: Louise C. Hawkley) was conducted by NORC at the University of Chicago with funding from the National Institute on Aging (grant number AG043538-08S1). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Table S1. Sample demographic characteristics. Table S2. Prevalence of older adults' social contact frequency and change in frequency by mode for non-household family members and friends. Table S3. Linear regressions of mental health outcomes on changes in social contact frequency since the pandemic started. Table S4. Inverse probability weighted linear regressions of mental health outcomes on changes in social contact frequency since the pandemic started. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. 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